Insertion of Elephant Trunk in Aortic Dissection Surgery with Guide Wire

主動脈剝離手術 Hi! I am Dr. Jeng Wei, director of Heart Center of Cheng-Hsin General Hospital, Taipei, Taiwan. Elephant trunk technique is commonly used in the open surgery for type B aortic dissection. With the use of vascular ring connector (Vasoring) and guide wire, the insertion of elephant trunk in the descending thoracic aorta became much easier and quicker. The ring was attached to the proximal end of the graft and is fixed to the distal aortic arch and the free end of the graft was pulled into the descending thoracic aorta with the aid of guide wire that was inserted through the femoral artery. The technique greatly reduced the surgical risk and most of our patients needed no blood transfusion during and after the surgery. 主動脈剝離是一種非常危險的疾病，大多數病人需要手術治療。然而手術治療的風險非常高，因此外科醫師常不敢嘗試，尤其對於B型的患者多採取保守的治療。避免開刀的結果可能換來暫時的寧靜，但日子久了還是逃不了破裂的命運。我是台北振興醫院心臟中心主任魏崢醫師，我的看法是該不該手術的大前提取決於手術的風險。若手術的風險很高，當然不如拖時間，那樣還可以多活幾年；但若是手術的風險不高，何不採取比較積極的態度，早點動手術，免得破裂時來不及治療。這段影片紀錄的是我們如何用自己發明的人工血管接環，再輔以導引鋼絲 (guide wire)，將人工血管置入降主動脈內，達到封閉內膜裂口的目的。如此一來可以將手術的風險已經降到最低，大多數病患在手術中與手術後也無需輸血。